鼻旁皮瓣在下睑退缩或外翻修复中的应用

Application of paranasal flap in the reconstruction of retraction or ectropion of lower eyelids

目的 介绍鼻旁皮瓣在下睑退缩或外翻修复中的应用方法.方法 沿患侧下睑缘0.2～0.3 cm处作切口并充分松解下睑挛缩,使下睑缘在睁眼时能遮盖虹膜0.2 cm,患侧上下睑能轻松、完全闭合.下睑缘的挛缩松解后,下睑部位皮肤缺损范围0.5 cm×2.1 cm～1.4 cm x3.2 cm.根据下睑皮肤缺损创面大小,在同侧鼻旁设计蒂在上方的鼻旁皮瓣并使切口缝合线在颌鼻缝上;皮瓣切取成功后,根据创面的深度对皮瓣皮下组织再作适当修剪,皮瓣旋转覆盖下睑创面后,皮瓣远端锚着固定于外眦处,创缘分层间断缝合;供区形成的继发性创面直接拉拢缝合;切取皮瓣面积0.6 cm×2.2 cm～1.5 cm ×3.5 cm,所有切取的皮瓣与创面大小匹配良好.结果 本组67例患者,创面均1期愈合.术后52例获随访1～36个月,下睑外形轮廓及视觉效果良好,修复组织与周围皮肤在色泽、质地、轮廓、光化性损害程度等方面有着很好的匹配,患侧上下睑能轻松、完全闭合,皮瓣供区切口线隐蔽较好且术后6～12个月后均不易察觉,获得满意的面部形态和美学效果.结论 遵循面部亚单位美学原则,应用鼻旁皮瓣修复下睑严重退缩或外翻,不仅操作方便,面部形态无明显改变,而且下睑可获得满意的功能和稳定的美学效果.

Objective To introduce the application of paranasal flap in the reconstruction of retraction or ectropiou of lower eyelids. Methods Incision was made along line which was 0.2 - 0.3 cm away from the palpehral margin and contracture of lower eyelids was fully loosen, which could cover 0.2 cm pupil while the eyes open, and the eyelids couhl be closed easily and completely. After loosening of the contracture, skin defective area of lower eyelid was 0.5 cm × 2. 1 cm - 1.4 cm × 3.2 cm. According to the size of the lower eyelid skin defects, paranasal flap in the ipsilateral nose with pedicle above it was designed, and the suture line was located on the maxillonasal suture; flaps were trimmed according to the depth of the wound and then revolved to cover the defects of lower eyelids, the distal end of the flaps were fixed to the lateral canthus; the secondary, defects of paranasal areas were directly sutnred. Results A total of 67 patients with retraction or ectropion of lower eyelids were treated with paranasal flap and healed primarily. About 52 of 67 patients were followed up for 1 - 36 months, and they were all satisfied with the contour of lower eyelids, gourd vision, good match of repaired tissue to its surrounding tissue, complete closure of upper and lower eyelids and concealed incision. Conclusion Based on the aesthetic subunit principle of face, paranasal flap can be used to reconstruct the retraction or ectropion of lower eyelids with such advantages as simple operation, non-changes of facial shape, satisfying function and stably cosmetic results of lower eyelids.